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contract

This form must be completed before you hire our products.

Conditions of Hire:

1. The Automatic Payment Authority must be completed,
signed and returned with this Contract for hire and
initial payment. Weekly payments of $30.00 (Ramsey Coote Alarm)
or $20.00 (Other Bedmat Alarm) will start
after four weeks of hire, calculated by BWS from the
estimated date you will receive your alarm. On return
of the alarm you need to cancel this with your bank (by
phone or Internet).
If a weekly automatic payment is not set up then four
weekly advance payments will be taken from
the nominated credit card.
2. As the equipment is valuable there is a $300.00 bond
held over the period of hire. The Bond is held as Visa or
MasterCard details. Note: We will not take any
monies off your card unless the hire conditions are not
met. These are the return of the alarm unit in good
condition and payment of outstanding fees. The expiry
date of the Visa or MasterCard must be greater than six
months from the date of hire.
3. Bedwetting Solutions will assist with any alarm related
problem. In the event of equipment problems,
Bedwetting Solutions will supply a replacement alarm
upon receipt of the current alarm. If fault is located
with the user, cost of postage and repair will be the
responsibility of the user. Please report any problems
immediately.
4. Bedwetting Solutions reserves the right to discontinue
hire of the alarm at our discretion if circumstances
dictate this, such as excessive length of hire.

Date

Name of Parent/Caregiver Home Address City Home/Work telephone

Mobile telephone

Email Confirm Email

Name of Child Childs Date of Birth (yyyy-mm-dd)

Childs Sex Approximate number of dry nights out of 28 Is there any wetting during the day? Is there any problem with constipation or soiling? Are there any breathing/ENT problems? How did you hear about Bedwetting Solutions?

We will contact customer for credit card details prior to alarm hire.

Note: No monies will be taken off your card unless the hire conditions are not met.

Card Number Expiry Date Name on the Card Are you a Human? I AGREE TO THE CONDITIONS OF HIRE

*You must agree to the conditions of hire on the left before sending this form